Spotlight Analytics Update

Spotlight Business Analytics helps healthcare organizations run custom analytics on health data including market share, patient origin, disease prevalence, cost of care, and comparative costs and outcomes for acute care hospitals.

We are working on some big enhancements to Spotlight that include incorporating new datasets. We have a big announcement and will have more information on this at our next Spotlight User Group Meeting on September 29. Please join us - register here to get the login details. Meanwhile, we're planning to hold meetings with current Spotlight users to discuss how these changes can help and meet the different needs and objectives of each user.

The current data status is:

Loaded & available for use:

• Massachusetts Hospital Inpatient Discharge Data FY19
• Rhode Island Hospital Inpatient Discharge Data FY19
• Massachusetts Emergency Department Discharges FY19

Received & ready for use soon:

• Rhode Island Hospital Inpatient Discharge Data FY20

Future planned data:

• Massachusetts Observation FY19
• Massachusetts Hospital Inpatient Discharge Data FY20
• Massachusetts Emergency Department Discharges FY20
• Massachusetts Observation FY20
• New Hampshire Facility Discharge Data Sets (Application pending)
• Maine Hospital Inpatient and Outpatient Data (Application pending)

Please feel free to drop us a line with any questions or comments at spotlight@mahealthdata.org. In the meantime, thank you for being a Spotlight Analytics user and a member of this community! Feel free to visit our Spotlight Business Analytics page or email us at the address above for more information.

DGC Update

NEHEN reduces administrative burden through the adoption of standardized transactions. It is a cornerstone service for payer and provider trading partners wishing to exchange industry standard X12, HIPAA compliant transactions in a real-time, integrated manner using APIs. Because of our unique governance, non-profit status, and membership-based model, NEHEN is able to offer very competitively priced services relative to the market.

NEHEN is in the process of presenting an advanced roadmap development plan put into motion by TriZetto Provider Solutions (TPS) and funded by a 20 million dollar, two year investment by TPS's parent company Cognizant, Inc. At the September Business Users Meeting we will present claims management developments completing the three part presentation. Previous presentations covered patient engagement and denials and contract management.

Several key features of this multi-part plan offering our members new benefits and features include PRE (Patient Responsibility Estimator) which will assist providers in meeting the requirements of the No Surprises Act federal requirements, claims attachments using the X12 275 standard, Medicare CSI (Claim Status Inquiry) and predictive claim outcomes using AI. Many other new features will also be available.

For information about NEHEN please contact us at members@nehen.org.

We all have a tendency to toss terminology around like everyone knows what it means and has a consistent, standard definition for what it encompasses. As new areas with new terminology emerge it's not that easy. Social determinants of health or SDOH is one of those developing areas where there's a lot of confusion and inconsistency. If you ask five people what it means you'll get ten answers. Toss in that any real conversation about related areas or how to address SDOH has to include observable indicators, direct causes, indirect causes, and areas that are already classified as other things (like demographics) and it really gets confusing. Then consider that attempts to address SDOH involve conversations about health equity, non-traditional care pathways, integration with social services, payment models, disability, privacy and consent, and even politics and things really get sticky. Having a clear definition for SDOH that everyone agrees upon that can then be acted upon is not easy.

So what is a social determinant of health? Ask us and we can come up with at least ten definitions, but what does the industry say about it? Here are some examples:

The Healthy People 2030 program at the Office of Disease Prevention and Health Promotion at HHS publishes the following definition:

"Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks."

The World Health Organization (WHO) uses this definition:

"The social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems."

Some organizations working in the SDOH space don't bother trying to define SDOH. HL7 FHIR Accelerator The Gravity Project doesn't provide a general definition. Rather, it defines individual social domains to explore in detail one at a time. Conversations bring in all sorts of factors, only some of which appear to fall into the general sense of the definitions above.

That said, these definitions, when they exist, are similar. However, when you dig deeper on the SDOH sections of each organization's website things get a bit murky. The Gravity Project works on social domains that are, at best, loosely associated with the general definitions and have large individual components (like disability, stress, and social connection). The WHO specifically talks about discrimination as a SDOH, bringing in all sorts of potential causes. So is the SDOH discrimination or is it the underlying identifier or condition that people are discriminating against? Is it all of the above?

At this point, you may be wondering why we care. That's simple. Most people agree that addressing SDOH is important to improving healthcare and particularly health outcomes for individuals affected by one or more SDOH. In order to do that we need data - data to identify people who have needs in this area, data to identify services available, data to track outcomes, and all sorts of other data. Useful data is standardized data with consistent format and meaning for all who use it. The first step in achieving this is defining what that data is. Then we can figure out how to collect it, exchange it, and use it in fruitful ways.

What does that mean? Is the social determinant of health transportation insecurity or is it the disability driving the transportation issues faced by a patient? Is it food insecurity or the lack of affordable grocery stores near where someone lives or the lack of funds needed to purchase food or the lack of employment to generate those funds? Is it housing insecurity or the spousal abuse causing someone to move around constantly? Does it even matter when we likely need to know all of the above (and a lot more) in order to reasonably attempt to address the actual issues faced by actual people experiencing difficulties?

As the Data Governance Collaborative starts to wrestle with these and similar questions we keep returning to the question "what is a social determinant of health?". Another area that's causing some consternation is the overlap between SDOH and other types of data. When you dig even a little bit, the cause of some of these larger issues often includes a demographic component - race, ethnicity, religion, gender, gender identity, and disability are just a few (is disability demographic data? That's another can of worms for another article). Many of these same factors are essential data for health equity work, another area that's often grouped into SDOH discussions adding to the confusion, and further complicating things is a lack of clarity around the boundaries between the two (it's not entirely clear such boundaries actually exist in any definitive way). Do we look at these as part of SDOH data as well as their other classifications or are they separate items that may have some impact?

We keep coming back to the question does it even matter? Our current answer is both yes and no. Having a workable definition for SDOH is important because the human brain requires some boundaries and constraints to think about ideas in constructive ways, so not having a clear definition is a barrier to doing the work. That said, if we use structured data for things then do we care if we capture something because it's a demographic or a SDOH or something else entirely? Maybe and maybe not. The problem is that so much of our data isn't structured, and so much of our current structured data doesn't use consistent, standard definitions. USCDI v2 requires the exchange of SDOH goals, assessments, problems, and interventions. It does not define these elements any further. Thus, defining these elements is part of the work to be done in implementing data specifications and exchange partnerships.

In order to do that, we have to understand the types of issues encountered by people that affect their health both in and out of the medical arena as well as how to start addressing them. The DGC is holding a series of Deep Dives to explore this with the wider world, but in our internal discussions one of our key questions remains "what is a social determinant of health?" As you can see, this isn't a straightforward question and we're still trying to figure out a good answer. We welcome your input. What do you think? Let us know at datagovernance@mahealthdata.org.